“I just bought that,” she said as she prepared for surgery for breast cancer the next day at University Hospital.
The 45-year-old pre-nursing student at Augusta Technical College was diagnosed with ductal carcinoma in situ, a cancer seemingly confined to the milk ducts of her left breast, which was picked up on her yearly mammogram. But even after a radical mastectomy to both breasts and seeming success, Hinson was left in somewhat of a quandary because her insurance company was refusing to pay for a genetic test that could tell her whether she is at increased risk for ovarian cancer and tell her daughters whether they are at increased risk for breast cancer later in life.
It was important to Hinson because her mother went through breast cancer seven years ago and did not get genetic testing because she was not a candidate.
Only 5 to 10 percent of breast cancers are caused by the inherited genes, according to the American Cancer Society, and less than 1 percent of the population carries the mutations. But for those families who are affected, the risk is much higher and Hinson wants to know whether her family is among them.
“I’m trying to get it done, for my children and for myself,” she said.
Hinson had been called back for suspicious spots on her mammogram before this year, so the call didn’t faze her. This time, however, it turned up a large mass, about 5.5 centimeters by 5.5 centimeters in the milk ducts of her left breast.
“I could see it myself (on the mammogram) and I said, ‘Ooh, I don’t want that in me. It’s got to go.’ ”
Fortunately, it appeared to be confined to the milk ducts, but Hinson was not a good candidate for a lumpectomy because removing the mass would take out too much tissue, said her surgical oncologist, Dr. Matthew Pugliese.
Because her right breast had appeared suspicious on earlier mammograms, Hinson decided to get both breasts removed.
“I don’t want to go through this again three, five years down the road, and be worried all of the time,” she said. “I’m 45, and I’ve got a lot of years left.”
After a 20-year career as a dental assistant, she is studying to become a nurse and the cancer is already changing how she sees herself and her future profession.
“I really feel that God is leading me to work in the oncology field as soon as I can complete my nursing degree,” Hinson said. “I just feel like I could offer more. I just wanted a career change and do something where I could help people.”
That is music to the ears of her mother, Linda Evancic, who is a longtime dialysis nurse at Doctors Hospital,
“When she told me she was changing to nursing, I was very surprised,” she said as she stood in a pre-op room waiting for her daughter to be taken to surgery. Hinson is in a hospital bed covered by a sheet, and her 15-year-old daughter, Bree, crawls under the sheet with her and snuggles up to her. It is hard to tell who is comforting whom.
“I just hope she doesn’t have to have chemo,” Evancic said. “That’s hard. I was so sick.”
In the operating room, Pugliese has outlined broad circles under the breast and on the far edges of the chest. He is also keeping in mind dark lines that plastic surgeon Billy Lynn has marked around the breasts, including long, diamond-shaped incision marks across the middle of the breast.
Those marks will eventually leave even pouches of skin after Pugliese has peeled back the skin from the flesh underneath and detached the breast tissue from the chest wall. Starting with the left breast, over the course of an hour he probes under the skin to the far edge of the chest and up to the collarbone, leaving as little breast tissue as possible.
“You don’t want to leave a drop,” Pugliese said. “Attention to surgical detail in risk-reducing cases becomes astronomically important.”
He will pull out the three closest lymph nodes to the left breast, stained blue by dye, which will become important in determining whether the cancer has spread. Lynn will help refine the breast pouches and put in tissue expanders that will be slowly filled to stretch the skin and later be replaced by breast implants.
About a week later, Hinson and her fiance, Dr. Wayne Linguiti, are sitting in Pugliese’s office. Sunny Bohannon, Hinson’s friend and a two-time cancer survivor, sits next to her.
Pugliese hands Hinson a copy of the pathology report on the breast tissue and lymph nodes. Hinson looks a little pale as she stares down at the sheet, as if someone had just handed her a grenade. Pugliese slowly explains the report then gets to the important thing, which is highlighted in bold.
“Lymph node No. 1: no evidence of any cancer seen. Lymph node No. 2: no evidence of any cancer seen. Lymph node No. 3: no evidence of any cancer seen.”
Hinson lets out a huge gush of air.
“Lymph node status is the single-most important prognostic factor in the surgical management of breast cancer care,” Pugliese said, as he writes “Nodes normal” on his copy.
Then he looks at the pathology of the left breast.
“The most important thing about this is there is no evidence of any invasion seen anywhere,” Pugliese said. “This is all in situ carcinoma. So there is no invasive disease.”
“That’s great news,” Hinson said.
The tumor was at least 3.5 centimeters from the chest wall.
“That’s a pretty good distance,” Pugliese said.
“They checked the right breast as well?” Hinson asked.
“The right breast is normal,” he said.
Hinson lets out another big sigh.
“So what’s that all mean?” Pugliese said. “It means that, once you heal up from the surgeries and have your plastic surgeries completed, you’re done. You’re done with breast care. There’s no need for any other therapies. There’s no indications for chemotherapy, no indications for radiation, no indications for risk-reducing pills.”
But while smiles break out around the room, there is one last thing. Hinson’s insurance carrier, WellCare of Georgia, is still balking at paying for the genetic test to see whether she carries the genetic mutations. Mutations in the BRCA gene, for instance, put patients at much higher risk of ovarian cancer, and patients should consider removing the ovaries as a precaution.
“If your test was to come back positive, we would recommend that to you as a way to do risk reduction for ovarian cancer,” Pugliese said. “If that test comes back normal, then there is no real benefit of you doing that.”
Hinson has more than that to think about – her two daughters.
“If it did come back positive I would definitely have my ovaries taken out,” she said. “And for my daughters’ sake I would like to know what their future might hold.”
Still, it is good news.
“Where’s the champagne?” Linguiti said, jokingly.
“You did a great job,” Hinson tells Pugliese, who seems a little embarrassed by the praise.
“I hope I never need you, but I know who to call,” Bohannon said.
Out in the waiting room, Hinson can’t quite bring herself to celebrate.
“He saw what he saw, and he said what he said, and it all sounds great,” she said. “But part of me doubts it.”
“You’ve got to keep believing and moving forward,” Bohannon said.
A week later, WellCare gives Pam Anderson at University the go-ahead to tell the lab in Utah to process Hinson’s sample.
“Finally,” Anderson said. It could be 10 days before the results come back.
On Wednesday, Hinson got bad news: She has the BRCA2 gene mutation and is likely facing more monitoring and probably more surgery. But, she said, at least she knows.
“I am definitely glad I know,” Hinson said.